Associate Provider File Representative

POSITION DESCRIPTION:

• Ensures compliance with parent company requirements, DOH regulations, internal, private business and governmental audits.

• Reviews and processes additions, updates, and deletions of provider information in the Provider File database.

• Ensures executions of data entry and updates are completed in a timely and accurate manner

• Maintain accurate data in provider file data systems.

• Maintain and initial setup of assignment accounts (AA) from the AA applications.

• Maintain accurate data of all applications, requests, changes, updates, and provider and customer information.

• Routinely contact external sources such as the Provider offices, state licensing agencies and provider reps to collect or clarify information or documentation, which in turn must be reviewed and evaluated against the established guidelines.

• Ensure files meet all regulations prior to updating the provider file.

• Contact external sources to collect or clarify information or documentation which in turn must be reviewed and evaluated against the established guidelines and procedures to ensure the file meets all policy and procedures in conjunction with regulations.

QUALIFICATIONS:

• Associate degree preferred.

• Excellent attention to detail.

• Motivated and positive team player.

• Excellent verbal, written and interpersonal skills.

• Ability to problem solve in a growing, expanding business.

• Proficiency in Microsoft Office (Outlook, Excel and Word).

• Ability to handle many tasks simultaneously and respond to customers and their issues promptly and professionally.

• Experience in Provider Data Management, Credentialing, Customer Services or Claims a plus.